Infections with MRSA tend to affect individuals with established risk factors and the involved strains have typical sensitivities. The MRSA isolate from this patient was resistant to flucloxacillin and fucidic acid but sensitive to ciprofloxacin and erythromycin. This unusual sensitivity pattern is similar to those of previously published Irish non‐ophthalmic CAMRSA.1
The atypical sensitivities and the history suggested a CAMRSA infection, so specimens were sent to the National MRSA Reference Laboratory for further testing. Polymerase chain reaction for the Panton‐Valentine leukocidin cytotoxin gene commonly found in CAMRSA was positive. The antibiogram‐resistogram type (AR) was unfamiliar, but similar to multilocus sequence (MLST) 80, which is the most commonly found genotype of CAMRSA in Europe.
CAMRSA with ophthalmic manifestations is rare. Rutar reported ophthalmic sequelae consisting of orbital cellulitis, endogenous endophthalmitis, panophthalmitis, lid abscesses, and septic venous thrombosis in a North American population with no evidence of recurrent disease.2
Known risk factors for transmission of CAMRSA include end stage renal disease, recent hospital admission, an outpatient visit, nursing home admission, antibiotic exposure, chronic illness, and close contact with a person with risk factors including health care contacts.3
Our patient did not have any of these, but did have contact with a fellow football player with similar pustular skin lesions.
Kazakova et al
reported an outbreak of CAMRSA among professional football players.4
Infection was associated with turf abrasion sites and a high body mass index. Huijsdens reported an outbreak of ST80 CAMRSA infection in members of a Dutch soccer team.5
The recurrent nature of sport associated CAMRSA has also been documented previously.4,5
Management of this patient's eczema may have been an important factor in the prevention of subsequent infections. Physical contact with infectious lesions, skin damage that facilitates bacterial entry, and sharing of infected equipment, clothing, or personal items may all result in the transmission of MRSA infection in athletes. Our patient fits into this group.
To our knowledge this is the first report of a European patient with an ocular manifestation of CAMRSA from a population of young healthy athletes with no established risk factors. Physicians must be aware of the increasing incidence of CAMRSA infections and the new clinical challenges these cases will present.